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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Neurological diagnosis in HIV patients is usually impeded by nonspecific technical findings and the multiplicity of AIDS-associated neuromanifestations. Despite its limited specificity EEG is of great diagnostic value in patients afflicted by the most common primary neuromanifestation, i.e., AIDS encephalopathy. In the setting of an advanced HIV-infection with typical symptoms and absence of focal neurological signs, parietooccipital slowing of the EEG basal activity may allow the diagnosis of AIDS encephalopathy. Additional advantages of the EEG method consist of its non-invasive nature and the feasibility of repeated examinations for follow-up. Although in secondary neuromanifestations the diagnosis will usually be established by CCT or MRI, focal EEG changes may be of additional diagnostic value.
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PMID:[Role of electroencephalography in the neurological diagnosis of HIV]. 251 81

Motor (postural tremor of the outstretched hands, most rapid voluntary alternating index finger movements and rise times of most rapid voluntary isometric index finger extensions) and psychometric tests (multiple choice vocabulary test - form b, syndrome short test, the German version of the standard progressive matrices - Raven, and the psychic and somatic findings according to the AMDP-system) as well as MRI-Scans were analysed in 100 HIV-infected patients of all stages according to the actual CDC-classification, but without any central-nervous or psychic deficit. Patients with drug, alcohol or tranquilizer abuse, opportunistic, cerebral infections or fever were excluded from the study. Tremor-peak-frequencies and reaction times did not show any significant difference to an age- and sex-matched control group; the other motor parameters revealed significant slowing in the patient group and a worsening with the CDC-stages. MRI-scans of all the patients were normal. The psychometric tests did not show significant alterations on a group statistical level, especially not in the depression scales. Morphologically, the motor performances of the HIV-infected patients resembled those of patients with basal ganglia diseases (M. Huntington, M. Wilson, M. Parkinson). Correspondingly, in some cases of clinically demented HIV-positive patients, MRI-scans showed lesions in the basal ganglia. It can be concluded, that there is an early subclinical central-nervous system affection in HIV-infected patients, especially of the basal ganglia, detectable with appropriate motor function tests sometimes considerably preceeding structural deficits seen later in the course of the disease in MRI-scans.
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PMID:[New electrophysiological findings on the incidence of brain involvement in clinically and neurologically asymptomatic HIV infections]. 251 87

The use of MRI in clinical psychiatry is evaluated on the basis of over four years' experience. Of 931 psychiatric patients examined, 156 were found to manifest pathological cerebral conditions, a frequency of 17 per cent, as compared with 2 per cent (2/101) among apparently healthy controls. The occurrence of intracerebral lesions, with exclusively psychiatric symptoms, is illustrated with case reports. The importance is stressed of early examination with neurodiagnostic imaging techniques in cases of psychiatric disorders where any of the following symptoms or preliminary diagnoses are present: atypical psychiatric features, first episode psychosis, late onset depression, dementia, HIV and other infections in conjunction with psychiatric symptoms, hysteria, and alcohol or drug abuse. The findings suggest MRI to be a useful supplementary diagnostic tool for improving the care of the psychiatric patient, while relieving the burden both on the patient's family and on mental health care resources.
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PMID:[Magnetic resonance tomography in psychiatry--clear benefits for health care services]. 258 13

This study examined the pattern of neuropsychologic abnormalities in three groups of subjects: 20 patients diagnosed with Acquired Immunodeficiency Syndrome (AIDS); 14 patients diagnosed with AIDS Related Complex (ARC); and 13 seronegative controls. Subjects with past history of chronic substance abuse, neurologic disease, or focal findings on MRI or CT were excluded. All subjects were administered a comprehensive neuropsychological battery. Results revealed a pattern of preserved attention and concentration, language skills, and most visuospatial construction abilities in the presence of more notable deficits in nonverbal memory and speeded psychomotor tasks. Practical implications for the early detection of HIV-1 related cognitive dysfunction are addressed.
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PMID:Neuropsychological performance in HIV-1 immunocompromised patients: a preliminary report. 280 63

Cerebral infection with human immunodeficiency virus can result in the development of symptoms covering a wide spectrum of psychiatric disorders and including adjustment disorders, affective disorders, delirium and dementia. The rapid and insidious nature of the disease requires an approach that relies on differential diagnosis, thorough psychiatric and neurological examination and, when indicated, additional tests such as EEG, LP, CT or MRI. The treatment of psychiatric symptoms is based on traditional pharmacological principles, although at lower doses due to the patients' propensity to develop delirium. Supportive psychotherapy and education of the patient and his family on the special aspects of HIV-associated psychiatric disorders are also cornerstones of treatment.
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PMID:[HIV infection of the central nervous system: psychiatric consequences]. 338 Oct 71

Seventy to eighty percent of HIV-infected patients exhibit neurological disorders at an advanced stage of the disease. In almost 90% of cases anatomical examination of brains shows histological lesions. Even when often reversible neurological disorders occur during the HIV primary infection, most of the manifestations of central nervous system (CNS) damage remains the prerogative of severe immunodepression. The principal CNS lesions associated with HIV infection are presented here with the clinical and biological elements that lead to the diagnosis. Cerebral toxoplasmosis holds a privileged place in these manifestations since it responds to an efficient curative and prophylactic treatment with a well-codified medical care based on the test treatment. Biological data, therefore, only have a contributing value. HIV encephalopathy is frequent, but the dementia syndrome is less frequent than the finding of associated imaging and pathological anatomy: atrophy and lesions of the white matter. Thus, the dementia complex is an elimination diagnosis. Cryptococcosis must be systematically considered, not only in patients with meningeal symptoms and headaches, but also with those with isolated fever. The demonstration of cryptococcus and cryptococcic antigen in the CSF has an almost absolute diagnostic value; imaging plays a very small diagnostic role, looking for an exceptional cryptococcoma. Multifocal progressive leukoencephalopathy benefits from the accuracy of MRI, and the diagnosis is usually based on clinical data, MRI and evidence of the virus in the CSF by PCR, even though the only mean of obtaining full proof is, in theory, stereotaxic biopsy. Primary cerebral lymphoma is the diagnostic alternative to toxoplasmosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical and paraclinical diagnosis of AIDS neurologic lesions]. 747 28

In order to evaluate the diagnostic and prognostic value of MRI in the very early stages of HIV infection, we have compared the results of postmortem brain MRI and neuropathological studies in 7 asymptomatic HIV seropositive individuals, 8 seronegative controls with similar cause of death and 6 patients who died of AIDS in the absence of focal cerebral changes (opportunistic infection or tumour). Cerebral atrophy was consistently evaluated by both techniques. Seropositive asymptomatic cases were significantly more atrophic than the seronegative controls and significantly less atrophic than AIDS patients. Small high signal intensity areas in the white matter and basal ganglia were not significantly more frequent in seropositives than in seronegatives. No corresponding lesion was found at neuropathological examination. Diffuse myelin pallor of the cerebral white matter on myelin preparation was somewhat more severe in seropositive asymptomatic cases than in seronegative controls and less than in AIDS cases. However, these differences were not statistically significant. No significant correlation could be found between neuropathological myelin pallor and diffuse signal abnormalities of the white matter on MRI. We conclude that brain abnormalities are present at the early asymptomatic stage of HIV infection. These include vasculitis with opening of the blood brain barrier and consequent myelin pallor and gliosis of the white matter, and moderate brain atrophy. However MRI correlates are discrete or non specific on post mortem examination, and some probably correspond to scars of transient vascular inflammation. It is very unlikely that MRI examination has any diagnostic or prognostic value at the early stages of the disease.
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PMID:[Early cerebral lesions in HIV infection. Postmortem radio-pathologic correlations in non-AIDS asymptomatic seropositive patients]. 747 29

Progressive Multifocal Leukoencephalopathy is a demyelinating disease. MRI shows high signal intensity areas on T2w sequence and low intensity aeras on T1w sequence, without enhancement after intravenous contrast injection. The involvement of arcuate fiber (U fibers) creates a sharp border with the cortex. There is no mass effect. Involvement of parieto-occipital areas is frequent. The lesions may be uni or bilateral, single or multiple; bilateral lesions are asymmetric. This typical appearance on MR images occurs in 90% of the patients with PML. Some atypical patterns may occur: focal hemorrhage, atrophy, faint peripheral enhancement and involvement of deep gray matter (basal ganglia). In most cases, the clinical and MR features provide the diagnosis. The main differential diagnosis, in MRI, is HIV-leukoencephalitis, but lesions are diffuse, less intense on T2w sequence and not visible on T1, without involvement of the arcuate fibers. Stereotactic biopsy should be performed only for atypical lesions, particularly in case of predominant involvement of deep gray structures.
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PMID:[MRI aspects of progressive multifocal leukoencephalopathy]. 747 33

Apart from the very frequent HIV encephalitis, which lays the foundation for opportunistic infections, the most common diseases encountered in HIV-infected patients are toxoplasmosis and lymphoma; the percentage of cases of other diseases is very small. It is capital to diagnose cerebral lymphoma at an early stage in these patients who already are in a precarious general and neurological state since this type of lesion usually occurs late in the natural course of AIDS. In the differential diagnosis between toxoplasmosis and lymphoma only stereotaxic biopsy enables a positive diagnosis to be made, but imaging methods, such as CT and MRI, provide data that help guide to a diagnosis which sometimes may be definitive. Suggestive of lymphoma is a single infiltrating lesion wider than 4 cm, which is paraventricular or located in the posterior fossa, has little perilesional alteration and a short tumoral doubling time during the imaging follow-up. Suggestive of toxoplasmosis are multiple, small, annular or nodular lesions with an important perilesional inflammation and usually located in basal ganglia. In addition, in MRI the kinetics of enhancement after contrast injection is intense and occurs early in lymphoma, in contrast with the toxoplasmic abscesses, and this should provide a more specific differential diagnosis. Scintigraphic studies with somatostatin or positron emission tomography, using fluorodeoxyglucose (FDG-PET scintigraphy), also seem to be an interesting mean of making a specific diagnosis of cerebral lesion, according to a principle that is close to dynamic MRI. In lymphoma, capturing of the tracer is about 3 times greater than in infective lesions, notably the toxoplasmic ones. Imaging, therefore, is provided with tools which permit an increasingly specific approach to the primary cerebral lymphoma of AIDS, the definitive diagnosis of which rests on stereotaxic biopsy. This high specificity facilitates a better selection of patients requiring this procedure and shortens the delay in its execution.
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PMID:[The diagnosis of primary cerebral lymphoma in AIDS. The contribution of imaging]. 747 39

This study was carried out using MRI (proton density--and T2-weighted) on 16 HIV-negative controls, 9 symptom-free HIV-positive patients and 25 with CDC IV HIV disease. The studies from this last group had previously been allocated by a radiologist to the following categories: 8 with focal mass lesions and normal-appearing white matter; 9 with diffuse encephalopathy (high signal on T2-weighted images, affecting most or all of the white matter) and 8 with patchy encephalopathy (high signal affecting only one or two areas within the white matter). Moran's I, a statistic of spatial autocorrelation, was calculated for the grey-scale values of a sampled pixel array from a central white matter region of each of the images. All values of Moran's I calculated in this study showed a large positive excess over the expected value under randomisation, indicating highly significant positive auto-correlation in the spatial arrangement of the grey-scale values. On T2-weighted images a statistically significant increase in the mean value of Moran's I, compared with controls, was found in the diffuse encephalopathy group, indicating that quantifiable changes in the spatial autocorrelation of pixel data can be related to recognised qualitative changes in the appearance of white matter in subjects with HIV disease. A lesser, but significant, rise in the mean value of Moran's I was also found in the focal mass lesion group, suggesting that changes in spatial autocorrelation may indicate pathological change in advance of qualitative MRI changes.
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PMID:Spatial data analysis in the quantitative assessment of cerebral white matter pathology on MRI in HIV infection. 747 47


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